Billing code 52284: Urethral dilationMedicare rate & RVUs in Missouri
Urologists report this cystourethroscopic procedure when treating a urethral stricture with mechanical balloon dilation and therapeutic drug delivery.
Medicare pays $2,327.92–$2,559.48 for 52284 in the office in Missouri, from Rest Of Missouri to Metropolitan St. Louis. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 52284 covers
A urologist passes a cystoscope to evaluate and access a urethral narrowing, then uses a drug-coated balloon catheter to mechanically widen the stricture and deliver medication to the treated area. The technique is used for urethral stricture disease, including recurrent anterior strictures, and may be performed in a facility or office-based procedure setting. Fluoroscopic guidance is included when performed; it is not required for the code’s description to fit.
Report the code when the documented treatment uses the drug-coated balloon approach, rather than ordinary dilation or incision of the stricture. The operative note should identify the stricture site and treatment performed, including balloon use and drug delivery. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy family pricing applies. Bilateral adjustment is inappropriate; assistant-at-surgery services are not paid, and co-surgeon and team-surgery billing are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 52284 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$2327.92 to $2559.48
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | $2,525.76 | $143.71 |
| Metropolitan St. Louis | $2,559.48 | $144.45 |
| Rest Of Missouri | $2,327.92 | $141.20 |
How the 52284 rate is calculated
Each of 52284’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 52284
RVUs × geographic indexes × conversion factor
Work3.02
3.02 RVUs× 1.000 GPCI
Practice expense76.91
76.91 RVUs× 1.000 GPCI
Malpractice0.39
0.39 RVUs× 1.000 GPCI
Adjusted RVUs
80.3200
Conversion factor
$33.4009
Medicare rate
$2,682.76
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 52284
The CMS indicators that decide how 52284 is paid alongside other services.
CMS payment indicators · 52284
Urethral dilation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
52284 without 51 · national office
$2,682.76
Urethral dilation
52284-51 · Second procedure: 50%
$1,341.38
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
52284 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 52281Urethral dilation
- Choose 52284 when treatment uses a drug-coated balloon for mechanical dilation and drug delivery. Code 52281 describes urethral stricture dilation by a different method.
- 52276Urethral stricture treatment
- 52276 is for endoscopic incision of a urethral stricture. This code is for balloon dilation with therapeutic drug delivery.
- 53600Urethral dilation
- 53600 describes urethral dilation by instrumentation without this cystourethroscopic drug-coated balloon treatment.
52284 billing questions
When should this code be chosen instead of 52281?
Use this code for cystourethroscopic treatment with a drug-coated balloon that mechanically dilates the stricture and delivers medication. Code 52281 describes a different dilation approach.
Is cystoscopy separately reported with this procedure?
The cystourethroscopic access and evaluation are part of this procedure. Do not separately report the same cystoscopy as though it were an independent service.
What documentation supports reporting it?
Document the urethral stricture and its site, the drug-coated balloon treatment, and the mechanical dilation and therapeutic drug delivery performed. Include fluoroscopy in the record when used.
Can modifier 50 be used for treatment on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure’s 0-day global period.
Can an assistant, co-surgeon, or surgical team be reported?
CMS does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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